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Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.

Publication ,  Conference
Phillips, BT; Lanier, ST; Conkling, N; Wang, ED; Dagum, AB; Ganz, JC; Khan, SU; Bui, DT
Published in: Plast Reconstr Surg
May 2012

BACKGROUND: Intraoperative vascular imaging can assist assessment of mastectomy skin flap perfusion to predict areas of necrosis. No head-to-head study has compared modalities such as laser-assisted indocyanine green dye angiography and fluorescein dye angiography with clinical assessment. METHODS: The authors conducted a prospective clinical trial of tissue expander-implant breast reconstruction with intraoperative evaluation of mastectomy skin flaps by clinical assessment, laser-assisted indocyanine green dye angiography, and fluorescein dye angiography. Intraoperatively predicted regions of necrosis were photographically documented, and clinical assessment guided excision. Postoperative necrosis was directly compared with each prediction. The primary outcome was all-inclusive skin necrosis. RESULTS: Fifty-one tissue expander-implant breast reconstructions (32 patients) were completed, with 21 cases of all-inclusive necrosis (41.2 percent). Laser-assisted indocyanine green dye angiography and fluorescein dye angiography correctly predicted necrosis in 19 of 21 of cases where clinical judgment had failed. Only six of 21 cases were full-thickness necrosis, and five of 21 required an intervention (9.8 percent). Risk factors such as smoking, obesity, and breast weight greater than 1000 g were statistically significant. Laser-assisted indocyanine green dye angiography and fluorescein dye angiography overpredicted areas of necrosis by 72 percent and 88 percent (p = 0.002). Quantitative analysis for laser-assisted indocyanine green dye angiography in necrotic regions showed absolute perfusion units less than 3.7, with 90 percent sensitivity and 100 percent specificity. CONCLUSIONS: Laser-assisted indocyanine green dye angiography is a better predictor of mastectomy skin flap necrosis than fluorescein dye angiography and clinical judgment. Both methods overpredict without quantitative analysis. Laser-assisted indocyanine green dye angiography is more specific and correlates better with the criterion standard diagnosis of necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, I.

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

May 2012

Volume

129

Issue

5

Start / End Page

778e / 788e

Location

United States

Related Subject Headings

  • Surgical Flaps
  • Surgery
  • Prospective Studies
  • Perfusion
  • Necrosis
  • Middle Aged
  • Mastectomy
  • Intraoperative Care
  • Indocyanine Green
  • Humans
 

Citation

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ICMJE
MLA
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Phillips, B. T., Lanier, S. T., Conkling, N., Wang, E. D., Dagum, A. B., Ganz, J. C., … Bui, D. T. (2012). Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. In Plast Reconstr Surg (Vol. 129, pp. 778e-788e). United States. https://doi.org/10.1097/PRS.0b013e31824a2ae8
Phillips, Brett T., Steven T. Lanier, Nicole Conkling, Eric D. Wang, Alexander B. Dagum, Jason C. Ganz, Sami U. Khan, and Duc T. Bui. “Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.” In Plast Reconstr Surg, 129:778e-788e, 2012. https://doi.org/10.1097/PRS.0b013e31824a2ae8.
Phillips BT, Lanier ST, Conkling N, Wang ED, Dagum AB, Ganz JC, et al. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. In: Plast Reconstr Surg. 2012. p. 778e-788e.
Phillips, Brett T., et al. “Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.Plast Reconstr Surg, vol. 129, no. 5, 2012, pp. 778e-788e. Pubmed, doi:10.1097/PRS.0b013e31824a2ae8.
Phillips BT, Lanier ST, Conkling N, Wang ED, Dagum AB, Ganz JC, Khan SU, Bui DT. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg. 2012. p. 778e-788e.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

May 2012

Volume

129

Issue

5

Start / End Page

778e / 788e

Location

United States

Related Subject Headings

  • Surgical Flaps
  • Surgery
  • Prospective Studies
  • Perfusion
  • Necrosis
  • Middle Aged
  • Mastectomy
  • Intraoperative Care
  • Indocyanine Green
  • Humans